Diagnosis and treatment of intractable idiopathic orofacial pain with attention-deficit/hyperactivity disorder

doi:10.1038/s41598-023-28931-3

. 2023 Jan 30;13(1):1678.

doi: 10.1038/s41598-023-28931-3.

Diagnosis and treatment of intractable idiopathic orofacial pain with attention-deficit/hyperactivity disorder

Satoshi Kasahara^{1

2}, Kaori Takahashi³, Ko Matsudaira^{4

5}, Naoko Sato⁶, Ken-Ichi Fukuda⁷, Akira Toyofuku⁸, Tatsuya Yoshikawa⁹, Yuichi Kato¹⁰, Shin-Ichi Niwa¹¹, Kanji Uchida¹²

Affiliations

¹ Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. namahage@king.odn.ne.jp.
² Department of Pain Medicine, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan. namahage@king.odn.ne.jp.
³ Department of Dental Anesthesiology, Tokyo Dental College, 2-9-18, Misakicho, Chiyoda-ku, Tokyo, 101-0061, Japan.
⁴ Department of Pain Medicine, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan.
⁵ Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
⁶ Nursing Department, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
⁷ Division of Special Needs Dentistry and Orofacial Pain, Tokyo Dental College, 2-9-18, Kanda-misakicho, Chiyoda-ku, Tokyo, 101-0061, Japan.
⁸ Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
⁹ Luxia Ginza Dental Clinic, 3-7-13 Ginza, Chuo-ku, Tokyo, 104-0061, Japan.
¹⁰ Department of Pediatric Dentistry, School of Life Dentistry at Tokyo, Nippon Dental University, 1-9-20 Fujimi, Chiyoda-ku, Tokyo, 102-8159, Japan.
¹¹ Department of Psychiatry, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Yazawa, Kawahigashi-Machi, Aizuwakamatsu, Fukushima, 969-3492, Japan.
¹² Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.

PMID: 36717626
PMCID: PMC9887013
DOI: 10.1038/s41598-023-28931-3

Diagnosis and treatment of intractable idiopathic orofacial pain with attention-deficit/hyperactivity disorder

Satoshi Kasahara et al. Sci Rep. 2023.

. 2023 Jan 30;13(1):1678.

doi: 10.1038/s41598-023-28931-3.

Authors

Satoshi Kasahara^{1

2}, Kaori Takahashi³, Ko Matsudaira^{4

5}, Naoko Sato⁶, Ken-Ichi Fukuda⁷, Akira Toyofuku⁸, Tatsuya Yoshikawa⁹, Yuichi Kato¹⁰, Shin-Ichi Niwa¹¹, Kanji Uchida¹²

Affiliations

¹ Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. namahage@king.odn.ne.jp.
² Department of Pain Medicine, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan. namahage@king.odn.ne.jp.
³ Department of Dental Anesthesiology, Tokyo Dental College, 2-9-18, Misakicho, Chiyoda-ku, Tokyo, 101-0061, Japan.
⁴ Department of Pain Medicine, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan.
⁵ Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
⁶ Nursing Department, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
⁷ Division of Special Needs Dentistry and Orofacial Pain, Tokyo Dental College, 2-9-18, Kanda-misakicho, Chiyoda-ku, Tokyo, 101-0061, Japan.
⁸ Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
⁹ Luxia Ginza Dental Clinic, 3-7-13 Ginza, Chuo-ku, Tokyo, 104-0061, Japan.
¹⁰ Department of Pediatric Dentistry, School of Life Dentistry at Tokyo, Nippon Dental University, 1-9-20 Fujimi, Chiyoda-ku, Tokyo, 102-8159, Japan.
¹¹ Department of Psychiatry, Aizu Medical Center, Fukushima Medical University, 21-2 Maeda, Yazawa, Kawahigashi-Machi, Aizuwakamatsu, Fukushima, 969-3492, Japan.
¹² Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.

PMID: 36717626
PMCID: PMC9887013
DOI: 10.1038/s41598-023-28931-3

Abstract

Attention-deficit/hyperactivity disorder (ADHD) has been reported to be associated with primary chronic pain syndromes, such as fibromyalgia, migraine, and chronic low back pain. Although idiopathic orofacial pain (IOP) is classified as burning mouth syndrome or persistent idiopathic facial or dentoalveolar pain and as a primary chronic pain, the association between IOP and ADHD has not been investigated. This retrospective cohort study investigated the severity of ADHD symptoms measured using the ADHD scale and the effects of treatment using ADHD drugs and the dopamine system stabilizer aripiprazole. The participants were 25 consecutive patients with refractory IOP referred to a psychiatrist and diagnosed with coexisting ADHD according to the Diagnostic and Statistical Manual of Mental Disorders-5. The ADHD scale scores were higher in patients with intractable IOP than those in the general population. Pharmacotherapy used in this study led to clinically significant improvements in pain, anxiety/depression, and pain catastrophizing. Intractable IOP and ADHD were shown to be associated. In the future, screening and pharmacotherapy for ADHD should be considered in the treatment of intractable IOP.

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Conflict of interest statement

The authors declare no competing interests.

Figures

**Figure 1**
Medication algorithm for intractable IOP with ADHD. *ADHD* attention-deficit/hyperactivity disorder, *APZ* aripiprazole, *ATX* atomoxetine, CL clonidine, *IOP* idiopathic orofacial pain, MP methylphenidate.

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Cited by

Improvement in persistent idiopathic facial pain with comorbid ADHD using the combination of a dopamine system stabilizer and psychostimulant: A case report.
Kasahara S, Kato Y, Takahashi K, Matsudaira K, Sato N, Fukuda KI, Toyofuku A, Niwa SI, Uchida K. Kasahara S, et al. Clin Case Rep. 2023 Jun 19;11(6):e7552. doi: 10.1002/ccr3.7552. eCollection 2023 Jun. Clin Case Rep. 2023. PMID: 37346882 Free PMC article.
Reappraising the psychosomatic approach in the study of "chronic orofacial pain": looking for the essential nature of these intractable conditions.
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References

1. International Classification of Orofacial Pain: 1st edition (ICOP). Cephalalgia.40, 129–221 (2020). - PubMed
1. Imamura Y, et al. An updated review on pathophysiology and management of burning mouth syndrome with endocrinological, psychological and neuropathic perspectives. J. Oral Rehabil. 2019;46:574–587. - PubMed
1. Benoliel R, Gaul C. Persistent idiopathic facial pain. Cephalalgia. 2017;37:680–691. - PubMed
1. Malacarne A, Spierings ELH, Lu C, Maloney GE. Persistent dentoalveolar pain disorder: A comprehensive review. J. Endod. 2018;44:206–211. - PubMed
1. Tan HL, Smith JG, Hoffmann J, Renton T. A systematic review of treatment for patients with burning mouth syndrome. Cephalalgia. 2022;42:128–161. - PMC - PubMed

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[1] International Classification of Orofacial Pain: 1st edition (ICOP). Cephalalgia.40, 129–221 (2020). - PubMed

[2] International Classification of Orofacial Pain: 1st edition (ICOP). Cephalalgia.40, 129–221 (2020). - PubMed

[3] Imamura Y, et al. An updated review on pathophysiology and management of burning mouth syndrome with endocrinological, psychological and neuropathic perspectives. J. Oral Rehabil. 2019;46:574–587. - PubMed

[4] Imamura Y, et al. An updated review on pathophysiology and management of burning mouth syndrome with endocrinological, psychological and neuropathic perspectives. J. Oral Rehabil. 2019;46:574–587. - PubMed

[5] Benoliel R, Gaul C. Persistent idiopathic facial pain. Cephalalgia. 2017;37:680–691. - PubMed

[6] Benoliel R, Gaul C. Persistent idiopathic facial pain. Cephalalgia. 2017;37:680–691. - PubMed

[7] Malacarne A, Spierings ELH, Lu C, Maloney GE. Persistent dentoalveolar pain disorder: A comprehensive review. J. Endod. 2018;44:206–211. - PubMed

[8] Malacarne A, Spierings ELH, Lu C, Maloney GE. Persistent dentoalveolar pain disorder: A comprehensive review. J. Endod. 2018;44:206–211. - PubMed

[9] Tan HL, Smith JG, Hoffmann J, Renton T. A systematic review of treatment for patients with burning mouth syndrome. Cephalalgia. 2022;42:128–161. - PMC - PubMed

[10] Tan HL, Smith JG, Hoffmann J, Renton T. A systematic review of treatment for patients with burning mouth syndrome. Cephalalgia. 2022;42:128–161. - PMC - PubMed

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Diagnosis and treatment of intractable idiopathic orofacial pain with attention-deficit/hyperactivity disorder

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Diagnosis and treatment of intractable idiopathic orofacial pain with attention-deficit/hyperactivity disorder

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Conflict of interest statement

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